Understanding the relation between routines and problem behaviors in children with clinical diagnoses

Abstract

The current study investigated the impact of routines on problem behaviors in children with the clinical diagnoses of either PDD, ADHD, or depression/anxiety. Previous research has identified negative relations between externalizing behaviors and routines as well as a link between using routines and having positive parenting. The study extends these findings to children with these various diagnoses and also to internalizing symptoms. In our sample negative relations were found between routines, as measured by the Child Routines Inventory (CRI), and both internalizing and externalizing symptoms when all groups were examined together. Additionally routines were found to moderate the relation between diagnosis and internalizing symptoms such that those with depression had the least amount of symptoms when they also had the most routines while the PDD and ADHD groups had the least amount of symptoms when they had moderate levels of routines. With respect to externalizing symptoms, no moderating effect was detected; instead, it was the case that more routines were related to less symptoms for all groups. It was found that the subscales of household and homework routines from the CRI accounted for the most variability in symptoms when all groups were examined together. In addition to the assessing the relation of routines and problem behaviors, the predictors of routines were also considered. The mediating role of parental distress on the relation between diagnostic status and routines was tested using the Baron and Kenny model (1986) for each diagnostic group compared to control. Specifically it was found that total parental distress, parental depression and parental anxiety were partial mediators in the depression group and that parental irascibility and parental depression were partial mediators in the ADHD group. In conclusion, it was found that clinically specific and appropriate use of routines is generally beneficial for a variety of children with clinical diagnoses. Additionally there are several possible models that are candidates for clinical intervention for distressed parents of children with depression and ADHD that may increase use of routine.